A Blog About Eating Disorders by Anna Knabe

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Food disappearing at a faster-than-normal rate, and elaborate excuses to explain the disappearance of food, such as explaining that the food went bad, fell on the floor, etc., and had to be thrown out.

Frequent statements such as, “I’m not hungry” or “I just ate”

Going to the bathroom after every meal

Frequent complaints of stomach problems (laxative abuse is a common method of purging)

Rapid weight loss or weight gain

Focus or fixation on body image and clothing size, and comparisons to others

In telling my Untold History of Gender Roles on the Internet, my work evolved from showing how the Internet affects (if at all) gender roles to how gender roles are expressed online. One of the first things that came as a surprise to me in starting research on my topic was that the Internet itself does not really affect the way we treat gender to any major extent. I thought this was an interesting point to express so in my first project, the Visual Essay, I showed how the Internet merely replicates the gender norms that we have previously been socialized to adopt.

I used this topic as a starting point for my Video Essay, by asking gender studies professor, Will Upchurch, what he thought about how the Internet affects gender roles (if at all). He was a very knowledgable and insightful interviewee and he took my question and went even further to explain how gender norms can be oppressive and harmful to both women AND men. I made a mental note to explore this theme of oppression and sexism in a later project (I ended up using this for my Remix and Remediation assignments).

First and foremost, I knew I needed to do at least one project on how men and women actually behave differently online. So for my next project, the Audio Documentary, I decided to conduct interviews of my male and female friends and use that material to incorporate my research findings on gendered behavior online. To my pleasant surprise, almost all of their answers aligned with my research, which gave me a rich collection of useful material.

I moved on from the analytical, research-based side of my project and decided to talk about a serious social issue: sexism. My Remix assignment was made up of a collection of images, GIFs, and music videos, that I found online, that all showed sexist attitudes towards women.

However, I was worried that only focusing on online sexism towards women was leaving my project a bit one-sided. After all, as Will Upchurch had said, sexism affects both genders, even males who benefit from patriarchy. Therefore, for my Remediation assignment I decided to recreate my Remix assignment from the male perspective. I thought this provided a good “ending” to my Untold history since this is an issue that often goes ignored and could be enlightening to people.

Overall, my projects pretty much boiled down to two overarching themes: the role of the Internet and the gender divide. I decided to set up my final website using these two major concepts. I also feel that my Video Essay provides the best general description of my topic so I will use that as an introductory piece on the homepage. Check out how my website is coming along here: http://www.wix.com/genderroles

“And she throws up whatever she eats.She leaves the bathroom with a nosebleed.”

Right off the bat he references eating disorders by blatantly stating said female’s bulimic behaviors and cocaine addiction (cocaine is often used to curb appetite by people with anorexia). As if this first sentence wasn’t apparently clear enough, the video was produced by Ana & Mia Music (Ana & Mia are slang for anorexia and bulimia in the online eating disorder communities).
Wale goes on to characterize the average resident in the 90120 area of Beverly Hills, California: the upper-class, white girl who’s willing to do virtually anything to get famous. His ultimate conclusion from this lyrical allegory is that it is racist to look down on a black person for their failures considering all the privileged white girls who go down equally bad paths. However, I think this song does a lot to expose the societal pressures that attribute to the development of eating disorders.

We know this fictional girl’s efforts to achieve stardom involve trying to lose weight through disordered eating when he raps,

“She barely eat at all, if she do she eat light.Indulge in a meal when the toilet’s in sight.”

“Expose those fries, can’t hold those down To read for Seven Pounds, you must release several pounds.”

These lines show a shift from this girls’ initial feelings of control over food to a total loss of control with the phrase “can’t hold those down”. Her disorder has started to take control over her rather than the other way around. “You must release several pounds” is the voice of her disorder demanding that she lose weight. Wale attributes this mental disortion to the media, specifically the film industry, when he references the Will Smith movie ‘Seven Pounds’. This girl won’t be able to get a part in the film unless she loses several pounds and achieves the ideal Hollywood figure.

“This is Heaven on Hell This is how she want to live But she ain’t really tripping, she’s on Beverly Hills”

The behaviors of someone with anorexia or bulimia may seem insane to the average, healthy person. However, in places like the Beverly Hills where the cultural pressure to be thin leaves no room for self-acceptance, acts like self-starvation and purging seem to be the norm. Wale even refers to her as a “Beverly Hill’s victim” which is an uncharacteristically sympathetic attitude for a rapper. Our society in general is often too harsh, underestimating the weight of the societal pressure to be thin as well as the level of difficulty it takes to overcome an eating disorder. If a rapper coming from the ghetto of Washington D.C. can acknowledge an affluent white girl with an eating disorder as a “victim”, then I think the rest of us could show a little more compassion for anyone dealing with a serious mental disorder.

Medical Insurance Coverage is Insufficient for Patients with Eating Disorders

Medical insurance companies have historically provided less coverage to patients with mental illness than those with a physical illness. However, mental illnesses such as eating disorders can be just as deadly. 10-20% of people with anorexia die, making it the deadliest mental illness there is. Eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating disorder affect people of all ages, genders, and races. Today, at least 14 million Americans suffer from diagnosable eating disorders.

Unlike most mood disorders like schizophrenia and depression, eating disorders are frequently denied coverage by health insurance providers. Eating disorders require extensive, long-term treatment because they are such complex issues. In the eyes of the insurance companies, they are vaguely defined, unpredictable, and expensive.

Part of the problem with lack of coverage is the stigma associated with these conditions. There is a sense of personal responsibility attached to a person’s eating habits so it is common for people to think that eating disorders are a personal choice rather than a deep-rooted mental disorder. However, according to the Eating Disorders Coalition, of all the factors that determine who develops an eating disorder, 50- 80% of those factors are genetic.

Major Types of Eating Disorders:

Anorexia Nervosa is an eating disorder characterized by self-starvation and excessive weight loss.

Bulimia Nervosa is an eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

Inpatient care: the patient stays in the facility and works with a team of specialists.

Partial residential: the patient goes home at the end of the day.

Outpatient: the patient sees therapists but lives independently.

(All Med: Healthcare Management, n.d.)

Patients who are extremely malnourished or underweight (usually with anorexia) are most likely to be admitted to inpatient treatment. Here the patient must undergo the process of restoration to a healthy weight as well as treatment of the psychological issues related to his or her eating disorder to prevent relapse. This requires an integrated process of physical, emotional, and mental healing through the use of medical care and monitoring, medications, psychotherapy, and nutritional counseling. Full completion of this multidisciplinary procedure is crucial for developing a lasting, healthy relationship with food.

Outcome studies following patients for 5 and 10 years after receiving treatment show that approximately 50% of these individuals recover, 25% improve with some residual symptoms, and 25% remain ill or die (Eating Disorders Coaltion, n.d.). Despite this success rate of treatment, only 1 in 10 people with an eating disorder actually receives treatment. Insurance companies are partially to blame for that.

Current State of Coverage

In 2011, the National Institutes of Health spent only $27 million on the study of eating disorders compared to $169 million for autism, and $264 million for schizophrenia. Yet the death rate for anorexia nervosa is double what it is for autism and for schizophrenia (Eating Disorders Coalition).

Insurance companies gauge a patient’s needs based on their Body Mass Index (BMI) which must be lower than 18.5. However, they do not take into consideration the psychiatric needs of patients who may be dealing with major emotional and mental issues that could severely endanger their health.

This restricting diagnosis allows insurance companies to get away with lending out even less-coverage dollars by ignoring the key psychological aspects of this disease. In fact, the majority of insurance providers refuse to cover even the cheapest treatment level: outpatient care.

50% of insurance companies cover only hospital care. Yet, there is a growing and impressive evidence base for cognitive, behavioral, and interpersonal psychotherapy for bulimia nervosa, and binge eating disorder, as well as family based interventions for youth with anorexia nervosa. (Eating Disorders Coaltion, n.d.)

For a patient who requires inpatient care, families without coverage often will pay around $20,000 just to have someone admitted. This is often a financially crippling but necessary action. Just one day of inpatient care runs around $1,700 (Cowell, 2012).

Currently the only option is fighting for coverage on a case-by-case level, however there is no guarantee that their requests will be granted without legislation requiring them to do so. Not to mention, many patients are psychologically impaired from malnourishment, making it difficult for them to barter with the insurance providers themselves.

According to a survey of 109 eating disorder specialists across the United States, representing nearly every inpatient eating disorders program in the country:

Nearly all specialists (96.7%) believe their patients with anorexia nervosa are put in life threatening situations because of early discharge mandated by health insurance companies refusing to cover treatment.

100% believe some of their patients suffer relapses due to limitations of managed care.

1 in 5 specialists believe that insurance company policies are indirectly responsible for the death of at least one of their patients.

83% report that they have had to reduce the average hospital stay of patients with anorexia nervosa because of managed care requirements.

Nearly all (98.1%) believe legislation will be necessary to alleviate this situation.

(Eating Disorders Coalition, n.d.)

Government Intervention

The government has continued to place eating disorders on the backburner of public health issues despite their urgency. The Obamacare health plan mandates that “any coverage plan offered under the health law’s new statewide insurance exchanges in 2014 must meet federal benchmarks across ten benefit categories, including essential expansions to prescription drug, maternity care, and mental health services.” (Mukerjee, 2012). Unfortunately, Obamacare fails to provide a clear definition of what constitutes a “mental health service”, leaving this part open to the interpretation of insurance companies.

Proposed Solution

So what kind of legislation should be implemented to alleviate this issue? The FREED Act, proposed in 2009, is the first bill in the history of Congress to address eating disorders research, treatment and education and prevention was proposed. FREED policy assistant, Kathleen MacDonald says. “Many sufferers have become what are referred to as “revolving door patients,” costing the insurance company repeated use of funds, and worse yet, many have lost their lives as a result of lack of care.” (Cowell, 2012).

The FREED Act would amend the Public Health Service Act (1944) to:

“Require a group health plan that provides medical and surgical benefits to also provide coverage for eating disorders. Applies such requirement to coverage offered in the individual market and coverage offered under the Federal Employees Health Benefit Program.”

(Bill Summary & Statistics, 2009-2010)

This act will require any insurer that provides health coverage for physical illness to provide coverage for eating disorders. Also, they will be required to:

Provide Care according to universally accepted criteria as written in the Practice Guidelines for the Treatment of Patients with Eating Disorders by the American Psychiatric Association.

The treatment setting must be appropriate to the patient’s needs and clinical presentation. Decisions regarding the treatment setting must include individual variables such as age, sex, ability to manage severity or co morbidity, family involvement, and staff expertise and training.

All treatment modalities should be covered, including but not limited to family, individual and group therapies, nutrition counseling, psychopharmacology, body Image therapy, and medical treatment.

(Eating Disorders Coalition, n.d.)

It is time to legitimize eating disorders as a national public health concern by providing patients with the proper care and treatment they need. Insurance companies continue to worm through the loopholes of BMI requirements to limit coverage Anorexia nervosa has a 10-20% mortality rate, making it the deadliest mental illness there is and insurance companies are operating under the belief that the treatment of eating disorders is not “cost effective”.

The FREED Act will provide specific guidelines for care and coverage to close up the loopholes that are causing so many patients to be denied help. FREED supports the belief that a human life is always “cost effective” and will ensure that everyone gets fair access to care.

The Eating Disorder Coalition is holding a National Lobby Day on Capitol Hill, April 17, 2013.